Investigación original / Original research Dental caries and treatment needs among indigenous people of the Potiguara Indian reservation in Brazil Fábio Correia Sampaio,1 Cláudia Helena Soares de Morais Freitas,1 Matilde Barbosa de Farias Cabral,2 and Ana Thereza de Azevedo Britto Machado 3 Suggested citation Sampaio FC, Freitas CHSM, Cabral MBF, Machado ATAB. Dental caries and treatment needs among indigenous people of the Potiguara Indian reservation in Brazil. Rev Panam Salud Publica. 2010;27(4):246–51. ABSTRACT Objective. The aim of this study was to assess the caries prevalence and treatment needs of Brazilian indigenous residents on an Indian reservation. Methods. This cross-sectional study comprised 1 461 individuals of ages 18–36 months and 5, 12, 15–19, 35–44, and 65–74 years living in the Potiguara Indian villages of Brazil. De- cayed, missing, or filled permanent teeth (DMFT) and deciduous teeth (dmft) were determined by calibrated examiners using the methodology recommended by the World Health Organiza- tion. Treatment needs were assessed with the guidelines of the 2003 Brazilian Oral Health Survey. Results. Means ± standard deviations (SD) for dmft of 18- to 36-month-old and 5-year-old children were 2.5 ± 3.7 and 5.8 ± 4.3, respectively. For the age groups 12, 15–19, 35–44, and 65–74 years, mean ± SD values of DMFT were 3.6 ± 3.1, 7.1 ± 4.9, 16.4 ± 7.5, and 22.8 ± 8.6. The mean ± SD number of deciduous teeth requiring treatment varied from 2.4 ± 3.5 to 5.0 ± 4.0 in the 18- to 36-month and 5-year-old age groups, respectively. Among adolescents and adults, it was observed that on average at least three permanent teeth required dental treatment such as fillings, crowns, endodontic treatment, and extractions. Conclusions. High prevalence of caries and many teeth needing treatment were observed in all age groups of the Potiguara Indians. Key words Dental caries; DMF index; dental health surveys; dental health services; indigenous population; Brazil. Data on oral health conditions among available indicated that caries prevalence remote areas indicate that they present a South American indigenous people is among Brazilian and Venezuelan Indians higher caries burden than those in urban scarce. Until the 1970s, the few reports was lower than in the urban population areas of the country, where improve- (1–4). Recently, some reports observed ments in oral health are taking place (6). that processed foodstuffs, such as white The high caries prevalence might be a 1 Departamento de Clínica e Odontologia Social, Uni- versidade Federal da Paraíba, João Pessoa, Brasil. sugar and soft drinks, have been incorpo- strong trend in several Indian reserva- Send correspondence to: Fábio Correia Sampaio, rated into the regular diet of many Brazil- tions of Brazil, and this situation might be Departamento de Clínica e Odontologia Social, Universidade Federal da Paraíba, Centro de Ciên- ian Indians (5). As a result of their chang- related to the level of contact with non- cias da Saúde, Campus I, João Pessoa, Brasil; e-mail: ing dietary habits, an increase in the indigenous groups. Certainly, cultural [email protected] caries experience is expected for many and geographic characteristics of each 2 Fundação Nacional de Saúde, João Pessoa, Brasil. 3 Secretaria de Saúde do Estado da Paraíba, João Brazilian indigenous groups. Recent data particular indigenous community may Pessoa, Brasil. from indigenous people living in rather dictate the strength of this process (7, 8). 246 Rev Panam Salud Publica 27(4), 2010 Sampaio et al. • Dental caries on Potiguara Indian reservation in Brazil Original research Since 1999, the Brazilian Indigenous Ethical issues kappa values for dental caries and treat- Health Care system has been centrally ment needs scores were higher than 0.89. coordinated by the National Health Following Brazilian regulations, the The international standards given by Foundation (FUNASA). In order to pro- study protocol was approved by the in- the World Health Organization were vide more information on indigenous stitutional ethical committee at the Uni- used to perform the epidemiologic sur- oral health status, FUNASA had stimu- versidade Federal da Paraíba. As indige- vey (14). The decayed, missing, or filled lated the development of epidemiologic nous people are the subject of this permanent teeth (DMFT) and deciduous surveys on many Brazilian indigenous research, the protocol was also submit- teeth (dmft) were assessed under indi- reservations. In 2001, the Special Indige- ted to the Potiguara Indigenous District rect natural daylight with dental mir- nous Health District in Paraíba, a north- in Paraíba and the National Commission rors, wood spatulas, and community pe- eastern state of Brazil, carried out a pre- of Research Ethics of the Brazilian Na- riodontal index probes throughout the liminary epidemiologic survey on the tional Health Committee for approval study. Tooth surfaces were dried with Potiguara Indian reservation aiming to (protocol number 12309/1700-05). gauze. The oral examinations were car- implement an oral health program. All subjects taking part in this research ried out in the selected houses and using These preliminary data showed a very signed an informed consent document. regular chairs. No specific position was high number of extracted teeth among Local leaders and parents signed for chil- applied because beds and sofas are not all age groups. Hence, it seems that oral dren and schoolchildren selected to par- available and most of the people sleep in health promotion was a neglected strat- ticipate in the study. hammocks. egy in that population. Dental treatment needs included the So far, there is no updated informa- Subjects and data collection assessment of fillings (one and two or tion about the caries experience in this more surfaces, crown, endodontic treat- population. Therefore, the aim of this For this cross-sectional study, the sam- ment, dental extraction, and sealants). study was to assess the caries preva- pling procedures and the age groups These criteria were based on the guide- lence and treatment needs related to were the same as those established by lines established for the 2003 Brazilian dental caries of the Brazilian indigenous the 2003 Brazilian Oral Health Survey Oral Health Survey (12). After data col- residents from the Potiguara Indian (12): 18–36 months and 5, 12, 15–19, lection, 10% of the subjects had oral reservation. 35–44, and 65–74 years of age. Also fol- exams in order to assess intraexaminer lowing the guidelines of the national variability. MATERIALS AND METHODS survey, the 26 Indian villages were clas- For those subjects 15–19, 35–44, and sified as rural areas and 12 of them were 65–74 years of age, a simple question- Area of study selected by using a systematic sampling naire was applied to collect information procedure that took into account the about the estimated date (in months) of The Potiguara (also known as Po- population distribution. The villages se- the last visit to a dentist and frequency of tyguara) are a nation of indigenous peo- lected in the municipalities were distrib- visits to a dentist per year; if they visited ple living on a reservation area located in uted as follows: Marcação (n = 2), Baía a dentist, they were requested to classify the Northeast Region, Brazil. The popu- da Traição (n = 5), and Rio Tinto (n = 5). the type of service (private or public). lation is estimated at 8 000 permanent in- All houses within a radius of 500 m from habitants distributed in 26 villages of the center of the selected village were Statistical analysis three municipalities (Marcação, Baía da visited. A minimal required sample size Traição, and Rio Tinto) in the state of of 1 138 individuals was calculated Mean ± standard deviation (SD) of Paraíba (9). based on the reference population for DMFT and dmft indexes were calculated The villages of the reservation lie on each age group. For sampling, a z value with the help of the SPSS software pack- the northern Atlantic coastal area of of 1.96 was applied to provide 5% signif- age (Statistics Package for the Social Sci- Paraíba, where many rivers support fish- icance. Furthermore, a 25% increase was ences, version 11.0). The chi-square test ing and local agriculture (corn, beans, included, aiming to compensate for pos- was used to verify whether the caries fre- rice, cassava) (10). The local temperature sible refusals, and resulted in a minimal quency observed was significantly differ- (mean annual values around 28°C) is target number of 1 425 individuals (13). ent from that expected for selected vari- favorable for tropical fruits, which are Finally, the sample of examined subjects ables (gender and geographic location). frequently consumed. The Potiguara In- was 1 461 individuals because of the un- A significance of 5% was set a priori. dians have been subjected to a strong ac- expected additional number of subjects One hundred and forty-five subjects culturation process and they have daily in the houses located in the 500-m area were reexamined for the intraexaminer direct contact with citizens from the established in some villages. kappa value. These subjects were ran- neighboring cities. In Baía da Traição, the Before the epidemiologic survey, cali- domly selected in accordance with their most populated urban area near the bration exercises comprising practical age group. This procedure resulted in reservation, water fluoridation is avail- and theoretical activities were carried 15–50 subjects in each age group, which able but the water pipes do not reach the out by dentists (n = 3). After 20 hours of provided a representative number of Potiguara reservation area. All residents training with volunteers belonging to the 10% of the total sample. The calculation of the Potiguara Indian reservation drink same age groups, interexaminer reliabil- of the kappa coefficient for intraexam- water with a very low fluoride concen- ity was assessed and 90% agreement was iner reliability for carious lesions tration (11).